Cases reported "Head and Neck Neoplasms"

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1/12. Porphyrin fluorescence and photosensitization in head and neck cancer.

    Indistinct margin demarcation and autofluorescence are problems in fluorescence delineation of porphyrin-containing head and neck squamous cell cancer (HNSCC). We studied the time course and in vivo localization of porphyrin fluorescence in a squamous cell cancer hamster model and in human HNSCC. After intravenous injection, a gradient in fluorescence intensity developed rapidly until tumors fluoresced above a lower-intensity mucosal background. Hamster tumor and ulcerated HNSCC without porphyrin injection demonstrated autofluorescence grossly indistinguishable from fluorescence in porphyrin-injected tumors. However, fluorescence microscopy revealed autofluorescence to be a surface phenomenon and showed injected porphyrin localized in tumor stroma. We conclude that autofluorescence must be considered when interpreting porphyrin fluorescence. In addition, empirically designed photodynamic therapy can be effective in selected HNSCC. Data from animal experiments provide useful guidelines for the delivery of this therapy.
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2/12. Hibernomas of the head and neck.

    Hibernomas are rare tumors derived from brown adipose tissue, a specialized form of fat tissue found in hibernating and nonhibernating animals. Only a minority of reported hibernomas have occurred in the head and neck region. This report describes two cases of cervical hibernomas, one of which was preoperatively diagnosed by the use of fine-needle aspiration biopsy. The clinical and pathologic characteristics of this neoplasm are reviewed. In general, hibernomas are slow-growing tumors with inconclusive evidence for the existence of a malignant variant. A review of the literature supports the conclusion that excision, sparing vital structures, appears to be curative.
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3/12. pasteurella infections of the head and neck.

    Infections caused by Pasteurella occur most frequently after domestic animal bites or scratches and in individuals with agricultural or veterinary contact with animals. A serious Pasteurella infection developed in an agricultural worker following tumor extirpation of a head and neck neoplasm. review of pasteurella infections in humans disclosed that 31 of 446 reported infections involved head and neck structures. The most serious of these involved the adjacent central nervous system. Surgical drainage combined with parenteral penicillin remains the treatment of choice in these infections. aminoglycosides are not effective in treating this organism.
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4/12. Clinical assessment of flap perfusion by fiberoptic fluorometry.

    perfusion fluorometry, a method which quantifies tissue fluorescence after intravenous fluorescein injection, has been highly predictive of skin flap survival in animals. It is advantageous because it is objective, simple, noninvasive, repeatable, and can be used to monitor flap perfusion constantly by following both uptake and elimination of dye. We applied this method clinically to a variety of flaps used in head and neck surgery. All flaps with good fluorometric values survived totally. Based on experience with 37 flaps, fluorometric indices have been established that accurately predict necrosis. Serial dye injections have been used to document transient flap ischemia in the early postoperative period. Representative cases illustrating the advantages of fluorometry in flap assessment are presented.
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5/12. Annulate lamellae in human malignant tumors: report of three cases.

    During the course of applying electron microscopy to diagnostic surgical pathological specimens, three malignant tumors (malignant melanoma, fibrous mesothelioma, lymphoblastic lymphoma) were found to contain annulate lamellae, distinctive intracytoplasmic organelles composed of membrane stacks interrupted by constrictions or pores. In one case both annuli and lamellae were present, a combination rarely described in human tissue and in animal models. In this material, the annuli of the annulate lamellae were structurally similar to nuclear pores. It is postulated that the abundant fibrils are probably related to the unusual configuration of the annulate lamellae. A morphologic relationship of the annulate lamellae to both the endoplasmic reticulum (cases 1 and 2) and the nuclear membrane (case 3) supports the theory that annulate lamellae may be related to both of these structures.
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6/12. Electrothrombosis as a treatment of cirsoid angioma in the face and scalp and varicosis of the leg.

    On the basis of the results of preliminary animal experiments, electrothrombosis was clinically utilized as a treatment for cirsoid angioma or varicosis. Seven patients with cirsoid angioma of the head and neck and two patients with varicosis of the leg treated by electrothrombosis technique are presented. Six were improved by electrothrombosis alone to the extent that no further treatment was required, while in three with angiomas, further surgery was needed to reduce the mass to normal size. The preceding use of electrothrombosis decreased the bleeding significantly. During follow-up from 18 months to 7 years, neither recurrence nor postoperative complications were encountered.
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7/12. Regression of head and neck carcinoma with a prostaglandin-synthesis inhibitor.

    The in vivo administration of a prostaglandin-synthetase inhibitor inhibited or reduced tumor growth in cancer patients and experimental animals. indomethacin, a prostaglandin-synthetase inhibitor and nonsteroidal anti-inflammatory agent commonly used in the management of arthritic patients, acted as an immune adjuvant by decreasing the production of prostaglandins. Seven cases demonstrated that indomethacin taken in the usually recommended dosages causes regression and stabilization of head and neck cancer. The following factors were also considered in this study: prostaglandin production, a survey of other reports of solid neoplasm response to prostaglandin-synthetase inhibitor administration, drug toxicity, irradiation therapy and metastases, the need for tumor biopsy, and the role that reduction in inflammation plays in tumor shrinkage.
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8/12. hypothyroidism in head and neck cancer patients: experimental and clinical observations.

    Damage to the thyroid gland may occur in patients undergoing treatment for head and neck neoplasms. This injury may result from damage incurred during surgery, from radiation therapy, or a combination of the two. Development of hypothyroidism is often insidious with potential harmful effects. An experimental study was performed to study the effects of hypothyroidism in pigs whose skin closely approximates that of the human. Wound tensile strength and flap necrosis were studied in the hypothyroid animal treated by surgery, radiation, and a combination of the two. The results of this study indicate that hypothyroidism alone has no significant unfavorable impact on wound tensile strengths or flap survival. When combined with preoperative radiation, however, there are statistically significant deleterious effects on both wound tensile strengths and flap survival. Histologically, collagen fibers within the wound appear shorter and thinner, which probably accounts for decreased wound tensile strengths. A clinical review of 62 head and neck cancer patients was also conducted. Within the study group, 10% of patients developed abnormally low thyroxine measurements, whereas 15% developed high thyroid-stimulating hormone levels as the only evidence of early primary hypothyroidism. hypothyroidism was not statistically related to tumor size, nodal status, clinical staging, or treatment group (surgery alone, radiation alone, or combination surgery and radiation). A previously unreported finding is that patients who develop a second primary tumor are significantly at risk for developing hypothyroidism. All patients diagnosed with a head and neck cancer should undergo baseline thyroid function testing, including measurement of TSH, and have serial repeat testing after treatment. Thyroid function determination should be mandatory in patients undergoing oncologic salvage procedures or treatment of a second primary tumor.
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9/12. Exposure to domestic cats: risk factor for pasteurella multocida peritonitis in liver cirrhosis?

    pasteurella multocida is most commonly associated with acute skin and soft tissue infections following an animal bite or scratch. peritonitis caused by P. multocida in patients with cirrhosis is rarely reported. We present a case of spontaneous bacterial peritonitis with P. multocida in a patient with cirrhosis, squamous cell cancer of the head and neck, and nontraumatic domestic cat exposure. Nasopharyngeal colonization with P. multocida, with subsequent transient bacteremia and seeding of the peritoneum in immunocompromised (particularly cirrhotic) cat-owners, could play an important pathogenetic role in the development of spontaneous bacterial peritonitis. A review of the literature showed that in nine of 13 patients with cirrhosis and P. multocida peritonitis, exposure to domestic animals was reported. The mortality rate is high in this setting, even with prompt antibiotic treatment. Preventive strategies for immuno-compromised patients should include minimization of animal contact, especially cats, which have a high carriage rate (70-90%) of P. multocida.
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10/12. hypercalcemia associated with infantile fibrosarcoma producing parathyroid hormone-related protein.

    We describe a 7-month-old boy who manifested severe hypercalcemia associated with mesenchymal neoplasm. A huge hypervascular tumor on the neck had been detected in prenatal ultrasonography. Surgical removal of the entire tumor at birth was not indicated, because the tumor was diagnosed as hemangioma. Chemotherapy and radiotherapy were attempted, but there was no effect on tumor growth. When the infant was 6 months old, the serum calcium level increased rapidly, associated with the expansion of the tumor. hypophosphatemia due to phosphaturia was also observed. serum PTH was undetectable, whereas the serum concentration of carboxyl-terminal (C-terminal) fragments of PTH-related protein (PTH-rP) was markedly elevated. Northern blot analysis and immunostaining demonstrated the expression of PTH-rP in the tumor. The tumor was transplantable to nude mice and caused elevation of circulating PTH-rP in the animals. Histological examination of the patient's bone revealed an increased number of osteoclasts. These findings were consistent with humoral hypercalcemia of malignancy caused by the excess production of PTH-rP. The tumor was identified histologically as infantile fibrosarcoma, which has not been reported as a cause of humoral hypercalcemia of malignancy to date. The expression of PTH/PTH-rP receptor messenger ribonucleic acid was detected in the tumor by the RT-PCR, suggesting that PTH-rP may have exerted its effect in the tumor in an autocrine/paracrine manner. In addition to the systemic effect of PTH-rP manifested as hypercalcemia, the PTH-rP secreted from the neoplasm could have been a local factor involved in the growth of the tumor.
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